title: Impact of fatigue on health-related quality of life in patients with Parkinson's disease: a prospective study.
abstract: OBJECTIVE
  To investigate the longitudinal association between the impact of fatigue and health-related quality of life and to determine if potential confounders distorted this association.
  
  
  METHODS
  Baseline, 3-, 6- and 12-week assessments of a randomized clinical trial were used.
  
  
  METHODS
  Outpatient rehabilitation centre.
  
  
  METHODS
  Patients with idiopathic Parkinson's disease.
  
  
  METHODS
  Quality of life was assessed with the Parkinson's Disease Questionnaire-39 and the Multidimensional Fatigue Inventory was used to assess fatigue. Time-independent and time-dependent factors were investigated for their bivariate association with quality of life by applying random coefficient analysis. Candidate confounders were successively added to the longitudinal association model to determine if the relationship between quality of life and fatigue was distorted. A change beyond 15% of found regression coefficient of the Multidimensional Fatigue Inventory was considered significant.
  
  
  RESULTS
  One hundred and fifty-three patients were included. Impact of fatigue was significantly associated with poorer quality of life (β = 0.24, 95% confidence interval = 0.18 to 0.30). This association was significantly distorted by depression (30.0%) and anxiety (24.1%). No distortion was found for other factors. After controlling for confounders, fatigue remained significantly associated with quality of life (β = 0.12, 95% confidence interval = 0.06 to 0.18, r (2) = 2.3%).
  
  
  CONCLUSIONS
  Our results suggest that patients who experience fatigue tend to report lower levels of quality of life. However, this longitudinal relationship is confounded by depression and anxiety and suggests that the unique contribution of fatigue to overall quality of life is rather small.
authors.affiliation: 1University of Applied Sciences Leiden, Leiden, The Netherlands.
authors.forename: Roy G
authors.initials: RG
authors.lastname: Elbers
authors.forename: Erwin Eh
authors.initials: EE
authors.lastname: van Wegen
authors.forename: John
authors.initials: J
authors.lastname: Verhoef
authors.forename: Gert
authors.initials: G
authors.lastname: Kwakkel
mesh_terms: D000368:Aged; D001007:Anxiety / Q000209:etiology*; D003863:Depression / Q000209:etiology*; D005221:Fatigue / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D010045:Outpatients; D010300:Parkinson Disease / Q000150:complications / Q000523:psychology* / Q000534:rehabilitation; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012047:Rehabilitation Centers; D018434:Sickness Impact Profile
keywords: Parkinson’s disease; anxiety; depression; fatigue; health-related quality of life